In Boston, House Calls for the Homeless

Dr. O’Connell and his team scour this city for the sick and homeless, administering H.I.V. drugs under bridges, dispensing soup to people sleeping on concrete benches and bandaging injuries from falls or scuffles.

The outreach is just one part of Boston Health Care for the Homeless Program, which brings the same kind of high-quality care found in Boston’s foremost medical centers to those who live — sometimes literally — in their shadows.

“The goal is to provide primary medical and mental health care,” said Dr. O’Connell, president and founder of the program, which he started 25 years ago. It is now the largest and most comprehensive in the nation. “And it has to be done with dignity. It has to stop being ‘homeless health care’ and be just ‘health care.’ ”

That care includes a comprehensive patient tracking system, hospital and shelter-based clinics, counseling services, referrals to detox programs and an H.I.V. team.

Homeless patients are referred to the complex by doctors at hospitals or at one of the 80 clinics the program operates in city shelters, racetracks and on the street.

The complex, called Jean Yawkey Place, is named after Ms. Yawkey, a Boston philanthropist and the wife of Tom Yawkey, the former owner of the Boston Red Sox (both are deceased).

The newly renovated building, which opened in July, is housed in the city’s old morgue, where it sits at a crossroads near a homeless shelter and Boston Medical Center.

To finance the renovation and to create building endowments, the program is in the midst of a $42 million capital campaign, which it hopes to complete by year’s end. So far it has raised $40 million. “Homeless people deserve the highest standard of care, and they shouldn’t not get it simply because they’re homeless,” said Dr. Monica Bharel, the program’s medical director. “They deserve it just as much as anyone else.”

James O’Toole, 54, said he would often be found drinking on the street, even though it was before noon on a Friday. Instead he was sitting in a clinic room, which he shares with three other men, tearing through the novel “Blood Work,” by Michael Connelly.

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HAVEN James OToole, whos been homeless for 15 years, waiting to see doctors for his broken jaw at Jean Yawkey Place, a new medical complex of Boston Health Care for the Homeless Program.Credit
C. J. Gunther for The New York Times

Mr. O’Toole, who has been homeless for 15 years, was staying in the inpatient clinic awaiting oral surgery necessitated by a broken jaw. He is also undergoing a battery of pulmonary and cardiac tests while he’s there.

Mr. O’Toole says he hopes a stay in the clinic will help him stay clean.

“This will help me get sober time, get healthy and get housing,” he said.

There are about 7,000 homeless people like Mr. O’Toole in Boston, according to an annual census conducted by the office of Mayor Thomas M. Menino, and countless others who are on the brink, said Dr. O’Connell.

Earning the trust of that community is the first, and most difficult, hurdle to overcome in providing health care. Services can’t be provided without trust.

“Our most important job is to build relationships,” Dr. Bharel said.

And that means getting out in the streets. The homeless community is much like any other, according to Dr. O’Connell. People tend to stay in the same places, with the same people, and are fiercely loyal to one another. There are fights and high drama, like anywhere else, but they are often brought on by alcohol or drugs. And there is a constant thought in the back of everyone’s mind.

“Death is a big current,” Dr. O’Connell said. “The idea of it is pervasive.”

A large part of his job is canvassing the streets, trying to ensure that death does not come early. Dr. O’Connell knows the homeless like few others in this city — their names, their stories, their medical and personal histories.

He keeps diligent notes in a small, spiral-bound notebook while out on the street, and later enters them into a comprehensive database the program keeps on every homeless person it encounters.

And the people he encounters and breaks through to don’t take his work for granted.

“He’s helped me so much,” said Kacia Wilkinson, who was homeless, clean for years and recently had a relapse. Ms. Wilkinson, who is H.I.V.-positive, was just released from jail after serving two months for driving while intoxicated with a minor in the car. Ms. Wilkinson met Dr. O’Connell at a city shelter.

Dr. O’Connell helped find her a treatment program, getting her back on a regular regimen of medication.

“I’m not a bad person,” she said as Dr. O’Connell took her blood pressure at the shelter. “I just want to go into a program.”

Getting the homeless into medical programs — including Dr. O’Connell’s — is a challenge, as demand far outstrips supply. In addition to patients referred by Boston Health Care’s clinicians, emergency rooms around the city send homeless patients to Jean Yawkey Place. It is a medical complex where patients can prep for a colonoscopy, stay during chemotherapy and, in many cases, die with dignity.

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GETTING HELP Leon, a drug abuser with liver cancer, is a patient at Jean Yawkey.Credit
C. J. Gunther for The New York Times

Enrolling patients often requires delicate negotiations with people who need care but do not want it, and treating others before sending them back to a shelter.

“Who is most at risk?” Dr. Bharel asked. “Who needs it most? It’s a challenge. If we had the space we’d take them all.”

That is where Boston Health Care’s clinics come in, administering medicine where the homeless and near-homeless live. Once a week a program van heads to Suffolk Downs, a racetrack in East Boston, where medical staff said they provided checkups for migrant workers who are afraid to seek medical care because of their illegal status.

The workers visit homeless shelters, where they administer flu vaccines, and they can cross-check the program’s database to find out what medications the patients are receiving. The workers also visit motels, seeing to the medical needs of people who are on the brink of homelessness.

“A big part of it is presence,” Dr. O’Connell said. “We have to be there to nurture. We have to be drawn into their lives to see what they’re going through.”

Cheryl Kane, a former teacher who became a nurse so she could work at Boston Health Care for the Homeless, said: “You never promise anything you can’t follow up on. You have to be a really consistent presence in people’s lives.”

On a recent morning at the complex, Ms. Kane greeted Richie, a longtime client who sleeps near Boston’s Faneuil Hall Marketplace. Richie marveled at the new building, made small talk with the staff and looked forward to taking a shower.

“This is nice,” he said.

Two weeks later, while riding along with a team from the Pine Street Inn, Boston’s largest homeless shelter, Dr. O’Connell encountered Richie, who was extremely intoxicated, could barely stand and needed to get into a shelter immediately. He had just relapsed after 10 days of sobriety.

Richie and another man, Barry, got into the van and started fighting. Having two people in a van is rare, said Nelson Bennett, who runs Pine Street’s night program, but both men were drunk, and it was cold.

After arriving at the shelter, Dr. O’Connell helped Richie and Barry get checked in, then came back to the van to resume canvassing the city.

In an ideal world, Dr. O’Connell said, Boston Health Care for the Homeless would not exist. While he hoped that providing top-notch health care would help change certain situations, it doesn’t always. Regardless, Dr. O’Connell and his team are dedicated to providing the best care possible right now, no matter what has happened in the past or will in the future.

“The hardest thing,” Dr. O’Connell said, “is that doing good health care for someone doesn’t mean their lives are going to fall right into place.”

A version of this article appears in print on , on page F12 of the National edition with the headline: In Boston, House Calls For the Homeless. Order Reprints|Today's Paper|Subscribe